Acceptance And Commitment Therapy: What To Know

Acceptance and commitment therapy, or ACT (pronounced like the verb “to act”) is a type of psychotherapy, or talk therapy, that focuses on mindfulness, acceptance and values. Developed in the 1980s by Steven Hayes, Ph.D., Kelly Wilson, Ph.D. and Kirk Strosahl, Ph.D., ACT promotes the idea that thoughts, feelings or circumstances that cause feelings of discomfort—such as pain, grief, disappointment or anxiety—are inevitable, and there are effective ways to adapt to challenges rather than suppress the unpleasant feelings that come with them.

ACT therapists operate under a theory that increasing acceptance can lead to increased psychological flexibility, or the ability to recognize and welcome sensations and thoughts in the present moment—even if they feel uncomfortable, according to Michelle Maidenberg, Ph.D., a licensed clinical social worker in New York. “This approach helps individuals stop avoiding certain thoughts or emotional experiences, which can lead to increased stress and suffering,” she says.

Alice Rizzi, Psy.D., a licensed psychologist in New York and telehealth provider in Florida, adds that ACT is a process-based therapy, meaning therapists help clients see what’s happening in the moment, how they act in different situations and what outcomes they get when they behave in a certain way. “It’s a bit like learning to read between the lines,” she says.

Rather than dismiss or judge difficult moments in life, ACT focuses on accepting, or being present for, experiences as they come without trying to change them. “It’s a skill developed through metaphors, mindfulness exercises and nurturing guidance that encourage you to build a new and more compassionate relationship with difficult experiences,” says Dr. Maidenberg.

Therapists who specialize in ACT teach clients mindfulness strategies to help them behave in ways that align with their personal values. “A lot of the work involves using metaphors and imagery to highlight the point of each process and help the client understand how to get from Point A to Point B,” says Dr. Rizzi.

There are six core processes in ACT that help people increase their psychological flexibility and serve their long-term values, versus acting on short-term impulses.

Here are the core processes:

Acceptance

Rather than avoiding or attempting to control unwanted emotions or sensations, acceptance techniques are all about willingly acknowledging these feelings with curiosity and without defense. “Acceptance involves full recognition and awareness of our feelings without trying to change them or ignore them,” says Dr. Maidenberg.

Cognitive Defusion

Defusion methods, like repeating the name of a feared object until it doesn’t feel as scary, involve changing the way we interact with or relate to certain thoughts. “This allows you to see thoughts simply as thoughts, stripped of the importance that your mind adds to them through evaluations, perceptions, judgments or criticisms,” says Dr. Maidenberg.

Being Present

This core process centers on voluntarily welcoming internal factors (such as emotions and thoughts) as well as external factors (such as what’s going on around you in terms of your home life, social life and finances). It helps people be more alert to what is happening in the moment, according to Dr. Maidenberg.

Self as Context

This concept aims to help individuals loosen their attachment to beliefs they have about themselves, thereby helping them develop a more flexible view of who they are. “This involves learning to see your thoughts about yourself as separate from your actions,” says Dr. Maidenberg.

Values

Not to be confused with goals, values are the principles or beliefs that a person finds meaningful and purposeful in their life. In ACT, values provide behavioral direction and motivation. “Personal values constitute a crucial component of ACT,” says Dr. Maidenberg. “This incorporates a variety of practices that allow individuals to understand the underlying value systems that guide and motivate their choices and behavior.”

Committed Action

This last process refers to the behavioral changes—with the help of goal-setting and pattern-building—that support a person’s chosen values. “ACT involves acquiring desirable traits, skills and knowledge to live a meaningful life and emphasizes the importance of consistent value-driven behavior,” says Dr. Maidenberg.

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“ACT can help people of all ages and backgrounds,” says Dr. Maidenberg. It can be used to treat many mental and physical conditions, including:

• Anxiety
• Depression
• Psychosis
• Substance abuse
• Chronic pain
• Eating disorders
• Stress
• Obsessive-compulsive disorder
• Psychological adjustment to cancer diagnosis and treatment

ACT is considered an evidence-based treatment, which Dr. Rizzi explains is a very distinguished accomplishment. “A therapy protocol has to go through many randomized controlled trials usually across many years and show that it is successful,” she says.

Several scientific and psychological bodies back ACT as an effective therapy, including the Society of Clinical Psychology and the American Psychological Association.

The Society of Clinical Psychology categorizes ACT as a therapy with “modest research support” when it’s used as a treatment for psychosis or obsessive-compulsive disorder. In order to meet “modest” criteria—the middle tier between “strong” and “controversial”—there must be one well-designed study or two or more adequately designed studies that support a treatment’s efficacy, according to the organization. Additionally, the American Psychological Association recognizes ACT as an empirically supported treatment not only for psychosis and obsessive-compulsive disorder, but also for depression, mixed anxiety disorders and chronic pain.

The Department of Veterans Affairs also endorses ACT as an evidence-based therapy for mood disorders.

“The efficacy of ACT has been evaluated in many randomized controlled trials investigating a broad range of target conditions,” says Dr. Maidenberg. Take, for instance, a 2020 review of meta-analyses in the Journal of Contextual Behavioral Science. Results show that across 20 meta-analyses, 133 studies and 12,477 participants, ACT is considered efficacious for all the conditions examined, which includes anxiety, depression, substance abuse and pain^[1]Gloster AT, Walder N, Levin ME, et al. The empirical status of acceptance and commitment therapy: A review of meta-analyses. Journal of Contextual Behavioral Science. 2020;18:181–192. .

To find an ACT therapist near you, you can start with a simple internet search or check out therapist directories at organizations like The Association for Behavioral and Cognitive Therapies and The Association for Contextual Behavioral Science.

Currently, there’s no official certification process for ACT (however, there are opportunities for providers to pursue higher expertise in ACT). To find a provider that has ACT training and actively uses ACT with clients, Dr. Rizzi recommends doing a little leg work. “I always encourage individuals to cross-reference [directory] profile pages with therapists’ actual websites, which tend to be much more thorough and give you a better idea of their individual style and level of experience,” she says. Then, she suggests setting up consultations so you can ask them about their experience with ACT and how they use it with clients.

So what can you expect when you practice ACT strategies? “You will understand a whole lot more about yourself and how you think, feel and respond to different situations, including how you interact with others,” says Dr. Rizzi. “When done properly, you will feel understood, validated and given the tools to go in a direction that is meaningful to you.”